Institute of Endocrinology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Clin Hypertens (Greenwich). 2019 Oct;21(10):1527-1533. doi: 10.1111/jch.13657. Epub 2019 Sep 5.
The diagnostic utility of different thresholds of elevated urinary fractionated metanephrine (UFM) for pheochromocytoma-paraganglioma (PPGL) was evaluated in 10 164 community-dwelling subjects (2012-2017). Levels were ≥1.5× the upper normal limit (UNL) in 276 subjects (2.7%) and ≥2×UNL in 138 (1.4%). PPGL was subsequently diagnosed in 59 (mean age 51.9 ± 14.3, 64% female); 58 (98.3%) with UFM ≥ 2×UNL. Positive predictive values (PPV) were 42% for UFM ≥ 2×UNL, 55% for UFM ≥ 2.5×UNL, and 69% for UFM ≥ 3×UNL. The main reason for PPGL screening (52.5%) was adrenal incidentaloma. Mean (median) metanephrine/normetanephrine levels were 6.7 ± 9×UNL (3 × UNL) and 6.1 ± 8.9×UNL (2.5 × UNL). Six patients (10.2%) had an extra-adrenal tumor (one malignant paraganglioma); one had bilateral pheochromocytoma. Only one patient presented with the "classic triad" (headache, palpitations, sweating). In conclusion, after excluding obvious reasons for false-positive results, thorough diagnostic assessment for PPGL is justified in all subjects with UFM ≥ ×2UNL. The PPV of milder UFM elevations is very low.
在 10644 名社区居民（2012-2017 年）中评估了不同尿分馏间甲肾上腺素水平升高阈值（UFM）对嗜铬细胞瘤-副神经节瘤（PPGL）的诊断效用。276 名受试者（2.7%）和 138 名受试者（1.4%）UFM 水平≥1.5×正常上限（UNL），≥2×UNL。随后诊断出 59 例（平均年龄 51.9±14.3，64%为女性）；58 例（98.3%）UFM≥2×UNL。UFM≥2×UNL 的阳性预测值（PPV）为 42%，UFM≥2.5×UNL 为 55%，UFM≥3×UNL 为 69%。PPGL 筛查的主要原因（52.5%）是肾上腺意外瘤。间甲肾上腺素/去甲肾上腺素水平的平均值（中位数）为 6.7±9×UNL（3×UNL）和 6.1±8.9×UNL（2.5×UNL）。6 名患者（10.2%）有肾上腺外肿瘤（1 例恶性副神经节瘤）；1 例双侧嗜铬细胞瘤。只有 1 例患者出现“三联征”（头痛、心悸、出汗）。总之，在排除假阳性结果的明显原因后，所有 UFM≥2×UNL 的患者均应进行彻底的 PPGL 诊断评估。轻度 UFM 升高的 PPV 非常低。
